Judges Reject Decades-Old Medicare Ban on Transgender Surgery

On May 30 and 31st, the media buzzed with reports that judges at Medicare had suddenly thrown out the longstanding federal ban on payment for transgender surgery.  For examples, see the CNN report, here, and USAToday's coverage, here.

I won't talk about the important social and societal issues, but if you would like more information on how the wheels turned, how the rules and procedures played out within the Medicare agency, and links to hard-to-find key documents, see more after the break.

* UPDATE: CMS RELEASES NEW NCD; JUNE 2016; HERE.

Using the Giant Medicare Physician Data Database

In April 2014, after years of legal efforts by multiple parties, including the Wall Street Journal, CMS released nearly 2 GB and some 10 million lines of physician data.   Both the Wall Street Journal and New York Times provide simple consumer friendly websites where you can look up a single doctor by name and zip code and see his Medicare billings for calendar year 2012.

Although it took most of a day, I was able to use the database for some client projects and I've made a Powerpoint deck and online 20 minute video that explains how the database(s) can be used. Details after the break.

An Online Video Course on Clarifying Discussions of Clinical Utility

This course summarizes PowerPoint seminars I've given in the first half of 2014 at several conferences and workshops.   Our peer-reviewed publication on the framework, Frueh & Quinn, 2014, appeared in July 2014, see here.

The thesis is that current simple frameworks for assessing diagnostic tests - like "analytical validity, clinical validity, clinical utility" are "real" in that they certainly do reflect actual different aspects of the test, but those six words are not modular enough to guide assessment.   That is, one has to bring a lot of content knowledge to those several words to do a technology assessment based on them.

Videos and PowerPoint downloads are available after the break.

Wednesday May 14: Washington Panel on Lab Markets after PAMA

PAMA is the acronym for the bundle of changes to Medicare policy that become law on April 1, 2014.  Most prominently, it deferred the physician pay SGR cut for a year.

Our firm, Foley Hoag, has a webpage describing the major impacts of PAMA on the diagnostics industry, here.

Details about the Webinar and conference we hosted on May 14, 2014, are stored after the break.

Lung Cancer Screening: CMS Advisory Panels Splits 180 degrees from USPSTF

Update: Proposed CMS Decision released, November 10, 2014:  See here.
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Last winter, the United States Public Services Task Force (USPSTF) issued a Grade B recommendation that low dose CT scans provide a health benefit in the age 50-80 population, who have > 30 pack years of smoking and who currently smoke or quit less than 15 years ago (see report here.)   Under the Affordable Care Act, commercial insurers will be required to offer this benefit, without copays, in a year or two.

In February, Medicare opened a decision analysis on whether to add this benefit to the Medicare program.  Medicare has undertaken this process and concurred with the USPSTF recommendation in numerous NCDs since 2010.   On April 30, Medicare held a public panel - a MedCAC advisory board - to discuss the low dose CT screening benefit for Medicare patients.   The Medicare panelist gave strikingly low votes that they had confidence the benefits would exceed the risks and uncertainties in the Medicare population.

My detailed notes on the meeting can be downloaded from online here. [50 pages including key figures presented, websites, and footnotes for most of the articles cited by speakers.  At the link, see the upper left arrow for 'download.']

(Update 9/24/2014: The CMS transcript of the full session, word for word, is now online here.)

For a brief trade journal review, the MedPageToday summary is here.   The Lung Cancer Alliance immediately expressed its "deep disappointment" with the panel's vote.